Uterine Fibroids: Should I Use GnRH-A Therapy?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

If you also have problems with
infertility, you may want to try another treatment.

Key points to remember

Taking
gonadotropin-releasing hormone analogue (GnRH-a) puts
your body into a state like menopause for as long as you take it. This shrinks
fibroids. After you stop taking it, your fibroids may grow
back.

Taking GnRH-a can cause serious side effects, such as bone
loss. To limit side effects, you take it for no longer than several
months.

GnRH-a therapy may be a good choice if you are close to
menopause (when fibroids shrink), have heavy bleeding
from fibroids, or are planning surgery. This medicine usually is not used to
relieve fibroid symptoms only, because fibroids grow back fairly quickly after
treatment stops.

It's possible-but not likely-for you to get pregnant while
taking GnRH-a. Be sure to use a barrier method of birth control, such as a
condom.

Over time, the size, shape, location, and
symptoms of fibroids may change.

As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, and other problems.

The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.

This medicine puts
your body into a state like menopause for as long as you take it. This lowers
your body's estrogen. This estrogen decrease:

Stops menstrual periods.

Stops
the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve pain and
bleeding only, because fibroids grow back fairly quickly after you stop taking
GnRH-a. But it is sometimes used to shrink large fibroids before fibroid
surgery or to stop heavy bleeding from fibroids.

For women who
are close to menopause (when fibroids will shrink on their own), short-term
relief from GnRH-a therapy can be a good choice.

Surgery to remove your uterus would cure your fibroids. But this
is a good choice only if you don't want to have children (or more
children).

Your symptoms
could get worse.

Fibroids could make it hard for you to get
pregnant.

You could have pain or infection from fibroid
embolization.

You could have side effects from taking
NSAIDs.

Birth control pills
have possible side effects, such as headaches and light or skipped periods.
They may be a risky choice if you smoke or have heart disease.

Personal stories about hormone therapy for uterine fibroids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I first noticed that my periods were
getting worse about a year ago. I wasn't too concerned, but I discussed the
pain with my doctor when I went for a Pap smear. My exam and Pap smear were
fine. My doctor said that uterine fibroids could be the cause of my pain. My mom and an older sister have had uterine fibroids, so I thought that must be
it. My doctor talked to me about my options. She told me that using birth
control pills and ibuprofen would be the best way to start. Now my periods are
lighter. And, when I start taking ibuprofen a few days before my period starts,
it really helps relieve my pain.

Amy, age 32

The pain
before and during my periods was so bad, I couldn't exercise. I am an active
person, and the pain was really getting me down. I have had uterine fibroids
for years and have tried ibuprofen and other nonprescription medicines, but
they were not helping anymore. When I went to see my doctor about the pain, she
said maybe it was time for surgery. I asked if there were any other options,
since the last time I had surgery it took me months to recover. I didn't want
to go through that again. My doctor said a hormone
medicine might help me. She said that it has side effects, so I
can't take it for longer than 6 months. That's okay, because menopause is right
around the corner for me, and fibroids get better after menopause. After
starting the medicine, I did have more hot flashes than usual, but my heavy
menstrual bleeding and menstrual pain are almost gone. I think taking this
medicine works well for me.

Patricia, age 52

I started having really painful menstrual
periods about 3 years ago. My doctor asked a lot of questions about my periods
and did an exam and some tests. Most of the tests came back normal, but my
doctor thought, based on the ultrasound, that uterine fibroids might be the
cause of my pain. I tried using a birth control patch for a few months, along
with ibuprofen, but it didn't work too well. But it was enough of an
improvement to make life tolerable. I really don't want to use any stronger
hormone medicine, because it makes you feel like you're in
menopause!

Susan, age
37

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take GnRH-a for fibroids

Reasons not to take GnRH-a for fibroids

My symptoms are bad, and other treatments haven't helped.

I can control my symptoms with other treatments.

More important

Equally important

More important

I'm only taking it for a few months, so I'm not worried about side effects.

I don't want to take any chance of having side effects.

More important

Equally important

More important

I want to treat my fibroids, even if they might come back.

I don't want to take hormones if they won't cure my fibroids.

More important

Equally important

More important

I don't plan to get pregnant.

I don't want to have to wait to get pregnant.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking GnRH-a

NOT taking GnRH-a

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Is GnRH-a a good choice to treat fibroids if you're close to menopause?

YesYou're right. GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

NoSorry, that's not right. GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

I'm not sureIt may help to go back and read "Get the Facts." GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

2.2, Will GnRH-a prevent pregnancy while you take it?

YesNo, that's not right. It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

NoYou're right. It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

I'm not sureIt may help to go back and read "Get the Facts." It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

3.3, Are side effects likely when you take GnRH-a?

YesYou're right. GnRH-a can cause bone loss if you take it for more than a few months. That's why doctors prescribe it only for short-term use. It also causes symptoms like those of menopause.

NoSorry, that's not right. GnRH-a can cause bone loss if you take it for more than a few months. That's why doctors prescribe it only for short-term use. It also causes symptoms like those of menopause.

I'm not sureIt may help to go back and read "What are the risks and side effects?" in the "Compare Your Options" chart. GnRH-a can cause bone loss and symptoms of menopause.

American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387-399.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Uterine Fibroids: Should I Use GnRH-A Therapy?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Use
GnRH-a to shrink fibroids before surgery, to stop
heavy bleeding, or to treat symptoms for a short time before menopause.

Choose another method to treat uterine fibroids, such as
over-the-counter pain medicine,
fibroid embolization, birth control pills, or
surgery.

This decision aid is for women who have decided to
treat their uterine fibroids. Many fibroids do not need treatment.

If you also have problems with
infertility, you may want to try another treatment.

Key points to remember

Taking
gonadotropin-releasing hormone analogue (GnRH-a) puts
your body into a state like menopause for as long as you take it. This shrinks
fibroids. After you stop taking it, your fibroids may grow
back.

Taking GnRH-a can cause serious side effects, such as bone
loss. To limit side effects, you take it for no longer than several
months.

GnRH-a therapy may be a good choice if you are close to
menopause (when fibroids shrink), have heavy bleeding
from fibroids, or are planning surgery. This medicine usually is not used to
relieve fibroid symptoms only, because fibroids grow back fairly quickly after
treatment stops.

It's possible-but not likely-for you to get pregnant while
taking GnRH-a. Be sure to use a barrier method of birth control, such as a
condom.

Over time, the size, shape, location, and
symptoms of fibroids may change.

As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, and other problems.

The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.

Depending on the reasons you need treatment, one type of
treatment may work better for you than another.

How does GnRH-a therapy work?

This medicine puts
your body into a state like menopause for as long as you take it. This lowers
your body's estrogen. This estrogen decrease:

Stops menstrual periods.

Stops
the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve pain and
bleeding only, because fibroids grow back fairly quickly after you stop taking
GnRH-a. But it is sometimes used to shrink large fibroids before fibroid
surgery or to stop heavy bleeding from fibroids.

For women who
are close to menopause (when fibroids will shrink on their own), short-term
relief from GnRH-a therapy can be a good choice.

Why might your doctor recommend GnRH-a?

You have severe bleeding from uterine
fibroids and need treatment right away.

Surgery to remove your uterus would cure your fibroids. But this
is a good choice only if you don't want to have children (or more
children).

What are the risks and side effects?

GnRH-a can cause bone
loss if you take it for longer than 6 months.

The medicine may give
you symptoms like those from menopause, such as hot flashes and vaginal
dryness.

The medicine only treats fibroids for a while. Fibroids tend to
grow back after you stop taking GnRH-a.

Your symptoms
could get worse.

Fibroids could make it hard for you to get
pregnant.

You could have pain or infection from fibroid
embolization.

You could have side effects from taking
NSAIDs.

Birth control pills
have possible side effects, such as headaches and light or skipped periods.
They may be a risky choice if you smoke or have heart disease.

Personal stories

Personal stories about hormone therapy for uterine fibroids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I first noticed that my periods were getting worse about a year ago. I wasn't too concerned, but I discussed the pain with my doctor when I went for a Pap smear. My exam and Pap smear were fine. My doctor said that uterine fibroids could be the cause of my pain. My mom and an older sister have had uterine fibroids, so I thought that must be it. My doctor talked to me about my options. She told me that using birth control pills and ibuprofen would be the best way to start. Now my periods are lighter. And, when I start taking ibuprofen a few days before my period starts, it really helps relieve my pain."

— Amy, age 32

"The pain before and during my periods was so bad, I couldn't exercise. I am an active person, and the pain was really getting me down. I have had uterine fibroids for years and have tried ibuprofen and other nonprescription medicines, but they were not helping anymore. When I went to see my doctor about the pain, she said maybe it was time for surgery. I asked if there were any other options, since the last time I had surgery it took me months to recover. I didn't want to go through that again. My doctor said a hormone medicine might help me. She said that it has side effects, so I can't take it for longer than 6 months. That's okay, because menopause is right around the corner for me, and fibroids get better after menopause. After starting the medicine, I did have more hot flashes than usual, but my heavy menstrual bleeding and menstrual pain are almost gone. I think taking this medicine works well for me."

— Patricia, age 52

"I started having really painful menstrual periods about 3 years ago. My doctor asked a lot of questions about my periods and did an exam and some tests. Most of the tests came back normal, but my doctor thought, based on the ultrasound, that uterine fibroids might be the cause of my pain. I tried using a birth control patch for a few months, along with ibuprofen, but it didn't work too well. But it was enough of an improvement to make life tolerable. I really don't want to use any stronger hormone medicine, because it makes you feel like you're in menopause!"

— Susan, age
37

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take GnRH-a for fibroids

Reasons not to take GnRH-a for fibroids

My symptoms are bad, and other treatments haven't helped.

I can control my symptoms with other treatments.

More important

Equally important

More important

I'm only taking it for a few months, so I'm not worried about side effects.

I don't want to take any chance of having side effects.

More important

Equally important

More important

I want to treat my fibroids, even if they might come back.

I don't want to take hormones if they won't cure my fibroids.

More important

Equally important

More important

I don't plan to get pregnant.

I don't want to have to wait to get pregnant.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking GnRH-a

NOT taking GnRH-a

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is GnRH-a a good choice to treat fibroids if you're close to menopause?

Yes

No

I'm not sure

You're right. GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

2.
Will GnRH-a prevent pregnancy while you take it?

Yes

No

I'm not sure

You're right. It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

3.
Are side effects likely when you take GnRH-a?

Yes

No

I'm not sure

You're right. GnRH-a can cause bone loss if you take it for more than a few months. That's why doctors prescribe it only for short-term use. It also causes symptoms like those of menopause.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

Use the following space to list questions, concerns, and next steps.

Credits

By

Healthwise Staff

Primary Medical Reviewer

Sarah Marshall, MD - Family Medicine

Primary Medical Reviewer

Kathleen Romito, MD - Family Medicine

Primary Medical Reviewer

Martin J. Gabica, MD - Family Medicine

Primary Medical Reviewer

Elizabeth T. Russo, MD - Internal Medicine

Specialist Medical Reviewer

Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology

References

Citations

American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387-399.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387-399.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.